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Cumulative psychosocial stress, coping resources, and preterm birth

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Abstract

Preterm birth constitutes a significant international public health issue, with implications for child and family well-being. High levels of psychosocial stress and negative affect before and during pregnancy are contributing factors to shortened gestation and preterm birth. We developed a cumulative psychosocial stress variable and examined its association with early delivery controlling for known preterm birth risk factors and confounding environmental variables. We further examined this association among subgroups of women with different levels of coping resources. Utilizing the All Our Babies (AOB) study, an ongoing prospective pregnancy cohort study in Alberta, Canada (n = 3,021), multinomial logistic regression was adopted to examine the independent effect of cumulative psychosocial stress and preterm birth subgroups compared to term births. Stratified analyses according to categories of perceived social support and optimism were undertaken to examine differential effects among subgroups of women. Cumulative psychosocial stress was a statistically significant risk factor for late preterm birth (OR = 1.73; 95 % CI = 1.07, 2.81), but not for early preterm birth (OR = 2.44; 95 % CI = 0.95, 6.32), controlling for income, history of preterm birth, pregnancy complications, reproductive history, and smoking in pregnancy. Stratified analyses showed that cumulative psychosocial stress was a significant risk factor for preterm birth at <37 weeks gestation for women with low levels of social support (OR = 2.09; 95 % CI = 1.07, 4.07) or optimism (OR = 1.87; 95 % CI = 1.04, 3.37). Our analyses suggest that early vulnerability combined with current anxiety symptoms in pregnancy confers risk for preterm birth. Coping resources may mitigate the effect of cumulative psychosocial stress on the risk for early delivery.

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Acknowledgments

We are extremely grateful to all the families who took part in this study and the whole All Our Babies team. Alberta Innovates Health Solutions Interdisciplinary Team Grant #200700595 provided funding for this cohort. Additional funding from the Alberta Children’s Hospital Foundation assisted with the analysis of data presented in this manuscript.

Ethical standards

This study was approved by the appropriate ethics committee and therefore was performed in accordance with the ethical stands laid down in the 1964 Declaration of Helsinki and its later amendments.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Paediatrics, University of Calgary, Calgary, AB, Canada

    Sheila W. McDonald, Hamideh Bayrampour & Suzanne C. Tough

  2. Faculty of Nursing, University of Alberta, Edmonton, AB, Canada

    Dawn Kingston

  3. Department of Obstetrics and Gynecology and Women’s Health, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA

    Siobhan M. Dolan

  4. Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada

    Suzanne C. Tough

  5. Child Development Centre, University of Calgary, c/o 2888 Shaganappi Trail NW, Calgary, Alberta, T3B 6A8, Canada

    Sheila W. McDonald

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  1. Sheila W. McDonald
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  2. Dawn Kingston
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  3. Hamideh Bayrampour
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  4. Siobhan M. Dolan
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  5. Suzanne C. Tough
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Correspondence to Sheila W. McDonald.

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McDonald, S.W., Kingston, D., Bayrampour, H. et al. Cumulative psychosocial stress, coping resources, and preterm birth. Arch Womens Ment Health 17, 559–568 (2014). https://doi.org/10.1007/s00737-014-0436-5

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